Organization
INITIUM NOVUM LLC
Active
Other names
Venom Performance Training
Organization subpart
No
Provider details
NPI number
Authorized official
TERRENCE VALENTINO BAILEY EXERCISEPHYSIOLOGIST (DIRECTOR OF HUMAN PERFORMANCE)
(310) 367-7517
Entity
Organization
Contact information
Practice address
1657 N MIAMI AVE APT 515, MIAMI, FL 33136-2010
(310) 367-7517
Mailing address
1657 N MIAMI AVE APT 515, MIAMI, FL 33136-2010
(310) 367-7517
Taxonomy
Speciality
Code
Description
License number
State
2083P0901X
Public Health & General Preventive Medicine Physician
Primary
—
—
251K00000X
Public Health or Welfare Agency
—
—
261QC1500X
Community Health Clinic/Center
—
—
261QC1800X
Corporate Health Clinic/Center
—
—
261QP2000X
Physical Therapy Clinic/Center
—
—
Other
Enumeration date
06/12/2019
Last updated
06/12/2019
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